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Shahbaz R, Charpentier E, Ponnaiah M, Deshours F, Kokabi H, Brochériou I, Le Naour G, Redheuil A, Koskas F, Davaine JM. In vitro analysis of carotid lesions using a preliminary microwave sensor to detect vulnerable plaques: Correlation with histology, Duplex ultrasound examination, and computed tomography scanner: The Imaging and Microwave Phenotyping Assessment of Carotid stenosis Threat (IMPACT) study. JVS Vasc Sci 2023; 5:100182. [PMID: 38384784 PMCID: PMC10879004 DOI: 10.1016/j.jvssci.2023.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/03/2023] [Indexed: 02/23/2024] Open
Abstract
Objective Progress in best medical treatment have made identification of best candidates for carotid surgery more difficult. New diagnostic modalities could be helpful in this perspective. Microwaves (MWs) can quantify dielectric properties (complex relative permittivity) of biological tissues and MW technology has emerged as a promising field of research for distinguishing abnormal tissues from healthy ones. We here evaluated the ability of a dedicated MW sensor developed in our laboratory to identify vulnerable carotid lesions. Methods We included 50 carotid lesions in this study. The plaques were analyzed and classified preoperatively by ultrasound (US) examination, computed tomography angiography and tested postoperatively using a MW sensor. Histopathological analysis was used as a gold standard to separate vulnerable plaques (VPs) from nonvulnerable plaques (NVPs). Results VPs were more frequently types 2 or 3 plaques (on US examination), had a greater proportion of low (<60 Hounsfield unit) and moderate (60-130 Hounsfield unit) attenuation components (computed tomography angiography) and displayed higher dielectric constant values (MW) than NVPs, which had an opposite profile. NVPs were more frequently asymptomatic plaques compared with VPs (P = .035). Multivariate analysis showed that US examination and MW identified VPs with a sensitivity of 77% and a specificity of 76% (cutoff value, -0.045; area under the curve, 0.848; P < .0001). Conclusions We found that the presence of types 2 to 3 (on US examination) and high dielectric constant plaques in vitro was highly indicative of a VP based on histological analysis. Further studies are needed to determine the potential of MW to identify the most dangerous asymptomatic carotid lesions.
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Affiliation(s)
- Rania Shahbaz
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Etienne Charpentier
- Sorbonne Université, Unité d'imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Maharajah Ponnaiah
- IHU ICAN, Foundation for Innovation in Cardiometabolism and Nutrition, Pitié Salpêtrière Hospital, Paris, France
| | - Frédérique Deshours
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Hamid Kokabi
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | | | - Gilles Le Naour
- Sorbonne Université, CNRS UMR8507, Laboratoire Génie Électrique et Électronique de Paris (GeePs), Paris, France
| | - Alban Redheuil
- Sorbonne Université, Unité d'imagerie cardiovasculaire et thoracique, Hôpital La Pitié Salpêtrière (AP-HP), Laboratoire d’Imagerie Biomédicale, INSERM, CNRS, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Fabien Koskas
- Department of Vascular and Endovascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Michel Davaine
- Medicine Faculty, Sorbonne Université, Paris, France
- Department of Vascular and Endovascular Surgery, Pitié-Salpêtrière University Hospital, Paris, France
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Li X, Liu C, Zhu L, Wang M, Liu Y, Li S, Deng Q, Zhou J. The Role of High-Resolution Magnetic Resonance Imaging in Cerebrovascular Disease: A Narrative Review. Brain Sci 2023; 13:brainsci13040677. [PMID: 37190642 DOI: 10.3390/brainsci13040677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
High-resolution magnetic resonance imaging (HRMRI) is the most important and popular vessel wall imaging technique for the direct assessment of vessel wall and cerebral arterial disease. It can identify the cause of stroke in high-risk plaques and differentiate the diagnosis of head and carotid artery dissection, including inflammation, Moya Moya disease, cerebral aneurysm, vasospasm after subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, blunt cerebrovascular injury, cerebral arteriovenous malformations, and other stenosis or occlusion conditions. Through noninvasive visualization of the vessel wall in vitro, quantified assessment of luminal stenosis and pathological features of the vessel wall can provide clinicians with further disease information. In this report, technical considerations of HRMRI are discussed, and current clinical applications of HRMRI are reviewed.
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Affiliation(s)
- Xiaohui Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Chengfang Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Lin Zhu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yukai Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Shuo Li
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Qiwen Deng
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
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3
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Jeon SY, Lee JM. Protected carotid artery stenting in patients with severe stenosis. Medicine (Baltimore) 2022; 101:e30106. [PMID: 35984161 PMCID: PMC9388035 DOI: 10.1097/md.0000000000030106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Intraplaque hemorrhage (IPH) and ulcers are the major findings of unstable plaques. In addition, initial symptoms are associated with postprocedural complications after carotid artery stenting (CAS). The aim of this study was to determine the safety of CAS using an embolic protection device in symptomatic patients with severe carotid artery stenosis and unstable plaques such as IPH and ulcers. This retrospective study included 140 consecutive patients with severe carotid stenosis. These patients underwent preprocedural carotid vessel wall imaging to evaluate the plaque status. We analyzed the incidence of initial clinical symptoms, such as headache, nausea, and vomiting, after CAS. The primary outcomes analyzed were the incidence of stroke, myocardial infarction, and death within 30 days of CAS. Sixty-seven patients (47.9%) had IPH, and 53 (38.9%) had ulcers on carotid wall imaging/angiography. Sixty-three patients (45.0%) had acute neurological symptoms with positive diffusion-weighted image findings. Intraluminal thrombi on initial angiography and flow arrest during CAS were significantly higher in patients with IPH and symptomatic patients. Symptoms were significantly higher in patients with IPH than in those without (63.5% vs 35.1%, P < .001). There were no significant differences in clinical symptoms after stenting or in primary outcomes, regardless of IPH, ulcer, or initial symptoms. IPH and plaque ulceration are risk factors in symptomatic carotid stenosis. However, IPH and plaque ulceration were not a significant risk factors for cerebral embolism during protected carotid artery stent placement in patients with carotid stenosis. Protected CAS might be feasible and safe despite the presence of unstable plaques.
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Affiliation(s)
- Seo-Young Jeon
- Jeonbuk National University Hospital & Medical School, Jeon-Ju, Republic of Korea
| | - Jong-Myong Lee
- Department of Neurosurgery, Jeonbuk National University Hospital & Medical School, Jeon-Ju, Republic of Korea
- *Correspondence: Jong-Myong Lee, Department of Neurosurgery, Jeonbuk National University Hospital & Medical School, 664-14, Deokjin-Gu, Jeonju, Jeonbuk 54907, Republic of Korea (e-mail: )
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4
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Bueno A, March JR, Garcia P, Cañibano C, Ferruelo A, Fernandez-Casado JL. Carotid Plaque Inflammation Assessed by 18F-FDG PET/CT and Lp-PLA 2 Is Higher in Symptomatic Patients. Angiology 2020; 72:260-267. [PMID: 33089697 DOI: 10.1177/0003319720965419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Carotid plaque inflammation assessed by 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are higher in symptomatic patients. The aim of this study was to assess correlations between 18F-FDG uptake on PET scan of carotid artery plaques, plasma levels of Lp-PLA2, and cerebrovascular symptoms. The study included 45 consecutive patients (22 symptomatic, 23 asymptomatic) with >70% carotid stenosis. Patients were examined by hybrid PET/CT, and maximum standardized uptake values (SUVmax) were recorded. Blood samples were obtained, and plasma was stored at -80 °C for subsequent Lp-PLA2 analysis. Symptomatic and asymptomatic patients showed no significant difference in classical cardiovascular risk factors. Asymptomatic carotid stenosis patients more frequently had a history of coronary artery disease (P = .025) and peripheral artery disease (P = .012). The symptomatic group had higher 18F-FDG uptake in carotid plaques (P < .001), higher plasma Lp-PLA2 (P < .01), and higher high-sensitive C-reactive protein (P = .022). 2-Deoxy-2-[18F]fluoro-D-glucose uptake on PET/CT and plasma Lp-PLA2 show a statistically significant association with the symptomatic status of carotid plaques.
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Affiliation(s)
- Alicia Bueno
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
| | - Jose Ramon March
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
| | - Pilar Garcia
- Getafe Health Research Institute, Madrid, Spain.,Nuclear Medicine Department, 16503Hospital Universitario de Getafe, Madrid, Spain
| | - Cristina Cañibano
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
| | - Antonio Ferruelo
- Department of Critical Care, 16503Hospital Universitario de Getafe, Madrid, Spain.,Ciber Enfermedades Respiratorias (CIBER), Getafe Health Research Institute, Madrid, Spain
| | - Jose Luis Fernandez-Casado
- Angiology and Vascular Surgery Department, 16503Hospital Universitario de Getafe, Madrid, Spain.,Getafe Health Research Institute, Madrid, Spain
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Wijeratne T, Menon R, Sales C, Karimi L, Crewther S. Carotid artery stenosis and inflammatory biomarkers: the role of inflammation-induced immunological responses affecting the vascular systems. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1276. [PMID: 33178808 PMCID: PMC7607082 DOI: 10.21037/atm-20-4388] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The death, disability and economic cost of stroke are enormous. Indeed, among the 16 million people worldwide who suffer a stroke' annually, nearly six million die, and another five million are left permanently disabled making prevention of stroke one of the most important priorities in healthcare. Currently carotid artery stenosis (CS) or narrowing of the common carotid artery (CCA) or internal carotid artery (ICA) due to atherosclerotic plaque, accounts for 20-30% of all ischemic strokes. Atherosclerosis is now regarded as a chronic inflammatory disease in response to vascular compromise especially from hypertension. This has long been known to lead to inflammation and atherosclerotic plaque formation in the blood vessels. This mini-review aims to highlight the role of inflammation and neuro-immunological processes in carotid artery disease. Various cellular elements of inflammation and advanced imaging techniques have been identified as potential markers of plaque progression. Therapies related to decreasing and modulating immune-responsive inflammation in the carotid vessels have been shown to translate into decreased occurrence of acute neurologic events and improvement of clinical outcomes.
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Affiliation(s)
- Tissa Wijeratne
- Department of Neurology, AIMSS, WHCRE level three, Sunshine Hospital and Melbourne Medical School, St Albans, Victoria, Australia.,School of Public health and Psychology, La Trobe University, Bundoora, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Rajarata University, Saliyapura, Anuradhapura, Sri Lanka
| | - Rohit Menon
- Department of Neurology and Stroke Service, Western Health, AIMSS, level 3, WHCRE, Sunshine Hospital, St Albans, Victoria, Australia
| | - Carmela Sales
- Department of Neurology and Stroke Service, Western Health, AIMSS, level 3, WHCRE, Sunshine Hospital, St Albans, Victoria, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Sheila Crewther
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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6
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Clinical significance of the internal carotid artery angle in ischemic stroke. Sci Rep 2019; 9:4618. [PMID: 30905965 PMCID: PMC6431677 DOI: 10.1038/s41598-018-37783-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/12/2018] [Indexed: 11/17/2022] Open
Abstract
The carotid artery plays a major role in stroke aetiology and is a good indicator of atherosclerosis. However, the clinical significance of internal carotid artery (ICA) anatomy remains unclear in patients with ischaemic stroke. This study examined the relationship between ICA angle and risk of ischaemic stroke. ICA angles of patients with acute ischaemic stroke were retrospectively compared with those of control patients between March 2014 and July 2014. Controls consisted of those with headaches but without ischaemic stroke. In both groups, ICA angles were measured using Maximum Intensity Projection images from computed tomography angiography, and the relationship between ICA angle and risk of ischaemic stroke was analysed. Of 128 screened patients with acute ischaemic stroke, 27 were enrolled, and 29 with headache were enrolled as controls. No differences were found in baseline characteristics between the two groups, but intracranial stenosis was more frequent in patients with stroke than in controls. Bilateral ICA angles were significantly larger in patients with stroke than in controls. Multiple logistic regression models showed that the right ICA angle was associated with risk of ischaemic stroke. Measuring the ICA angle may help assess the risk of ischaemic stroke.
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7
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Belov YV, Sinyavin GV, Barinov EV, Grabuzdov AM. [Contrast-enhanced ultrasonography as the most perspective diagnostic method for unstable atherosclerotic plaque of carotid artery]. Khirurgiia (Mosk) 2018:52-56. [PMID: 30307422 DOI: 10.17116/hirurgia2018090152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Problem of internal carotid artery disease diagnosis appears to be crucial today. Complications of this pathology are strokes and transient ischemic attacks. There is no technology for their prediction or at least stratifying risks. Some recent researches are devoted to a new diagnostic method. This new technology is called Contrast Enhanced Ultrasonography (CEUS) and followed by outstanding results in studying the morphological peculiarities of internal carotid artery plaques and predicting the probability of complications. CEUS is a new way for atherosclerotic process analysis because it is able to detect intraplaque neovascularization and vascular wall inflammation.
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Affiliation(s)
- Yu V Belov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia; Sechenov First Moscow State Medical University, Chair of Hospital-Based Surgery #1, Moscow, Russia
| | - G V Sinyavin
- Sechenov First Moscow State Medical University, Chair of Hospital-Based Surgery #1, Moscow, Russia
| | - E V Barinov
- Sechenov First Moscow State Medical University, Medical Faculty, 5
| | - A M Grabuzdov
- year, Moscow, Russia ,Sechenov First Moscow State Medical University, International School 'Medicine of the Future', 5 ,year, Moscow, Russia
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8
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Belov YV, Sinyavin GV, Bredikhina AI, Guseva EV, Barinov EV, Lukyanova EA, Luzan PY. [Imaging of neoangiogenesis of internal carotid artery's atherosclerotic plaque by contrast-enhanced sonography and histological examination]. Khirurgiia (Mosk) 2018:90-95. [PMID: 30113602 DOI: 10.17116/hirurgia2018890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previously, atherosclerosis was considered a disease accompanied exclusively by lipids accumulation. At present time success of fundamental and experimental science confirmed that atherosclerotic process is also associated with neovascularization and prolonged inflammatory response at all stages of atherogenesis from initial manifestations to thrombotic complications. The cause of atherosclerotic plaque instability is neovascularization, which is accompanied by intra-plaque hemorrhage and damage. Complications of carotid arteries atherosclerosis are strokes and transient ischemic attacks. The use of a wide range of diagnostic and pathohistological techniques is required for assessing this pathology. The most promising diagnostic technique is Contrast Enhanced Ultrasonography (CEUS) which allows to assess neovascularization degree in atherosclerotic plaque through the injection of a contrast agents.
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Affiliation(s)
- Yu V Belov
- Petrovsky Russian Research Center for Surgery, Moscow, Russia; Sechenov First Moscow State Medical University, Medical Faculty, Department of Hospital-Based Surgery #1, Moscow, Russia
| | - G V Sinyavin
- Sechenov First Moscow State Medical University, Medical Faculty, Department of Hospital-Based Surgery #1, Moscow, Russia
| | - A I Bredikhina
- Sechenov First Moscow State Medical University, Medical Faculty, Moscow, Russia
| | - E V Guseva
- Sechenov First Moscow State Medical University, Medical Faculty, Moscow, Russia
| | - E V Barinov
- Sechenov First Moscow State Medical University, Medical Faculty, Moscow, Russia
| | - E A Lukyanova
- Pirogov Russian National Research Medical University, Pediatric Faculty, Moscow, Russia
| | - P Yu Luzan
- Pirogov Russian National Research Medical University, Pediatric Faculty, Moscow, Russia
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9
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Functional Assessment of Intermediate Vascular Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7619092. [PMID: 29850561 PMCID: PMC5925208 DOI: 10.1155/2018/7619092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/12/2017] [Accepted: 01/28/2018] [Indexed: 11/19/2022]
Abstract
Interventional treatment in various vascular beds has advanced tremendously. However, there are several problems to be considered. We searched the literature and tried to analyze major parts of it. One is safety and applicability of coronary proven methods in other vascular beds. An unresolved problem is the functional assessment of intermediate lesions, as far as various target organs have quite different circulation from the coronary one and the functional tests should be modified in order to be applicable and meaningful. In the majority of the acute vascular syndromes, the culprit lesion is of intermediate size on visual assessment. On the other hand, a procedurally successfully managed high-degree stenosis is not always followed by clinical and prognostic benefit. In vascular beds, where collateral network naturally exists, the readings from the functional assessment are complicated and thus the decision for interventional treatment is even more difficult. Here come into help the functional assessment and imaging with IVUS, OCT, high-resolution MRI, and contrast enhanced CT or SPECT. The focus of the current review is on the functional assessment of intermediate stenosis in other vascular beds, unlike the coronary arteries.
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10
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Is Carotid Plaque Contrast Enhancement on MRI Predictive for Cerebral or Cardiovascular Events? A Prospective Cohort Study. J Comput Assist Tomogr 2017; 41:321-326. [PMID: 27824664 DOI: 10.1097/rct.0000000000000506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to correlate carotid plaque contrast enhancement (CPCE) to onset of cerebral/cardiovascular events (CCVE) in patients with atherosclerotic carotid disease. METHODS The ethics committee approved this prospective study. Patients with carotid artery stenosis underwent magnetic resonance angiography before/after injection of 0.1 mmol/kg of gadobenate dimeglumine. Carotid plaque contrast enhancement was graded as follows: 0, no CPCE; 1, 1 single enhancement focus; 2, 2 or more foci. RESULTS Seventy-seven patients (71 ± 9 years) had a stenosis degree: 34 mild, 16 moderate, 27 severe at the right side, and 36, 15, and 25 at the left side. Carotid plaque contrast enhancement was 0 in 30 patients, 1 in 26, 2 in 11 at the right, and 37, 19, and 13 at the left. Forty-seven CCVE occurred after magnetic resonance imaging, correlated to both stenosis degree (P = 0.006) and CPCE (P = 0.032). Excluding surgery/stenting, the correlation held only for CPCE (P = 0.017). Of 49 patients showing CPCE, 5 (10%) reported CCVE; of 21 patients without CPCE, none reported CCVE (P = 0.129). CONCLUSIONS The absence of CPCE seems to be a negative predictor for CCVE.
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Rübenthaler J, Reiser M, Clevert DA. Diagnostic vascular ultrasonography with the help of color Doppler and contrast-enhanced ultrasonography. Ultrasonography 2016; 35:289-301. [PMID: 27669962 PMCID: PMC5040140 DOI: 10.14366/usg.16027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/05/2022] Open
Abstract
The use of ultrasonography and especially of contrast-enhanced ultrasonography (CEUS) in the diagnosis of vascular pathologies before and after interventions has significantly increased over the past years due to the broader availability of modern ultrasound systems with CEUS capabilities and more trained user experience in this imaging modality. For the preinterventional and postinterventional work-up of carotid diseases, duplex ultrasound as well as CEUS have been established as the standard-of-care examination procedures for diagnosis, evaluation, and follow-up. In addition to its use for carotid arterial diseases, ultrasonography has also become the primary modality for the screening of vascular pathologies. This review describes the most common pathologies found in ultrasonography of the carotid arteries, the abdominal aorta, and the femoral arteries.
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Affiliation(s)
- Johannes Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - Maximilian Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
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Georg Y, Ohana M, Chakfe N. Commentary on 'Carotid Anatomy Does Not Predict the Risk of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Artery Stenting in the ICSS-MRI Substudy'. Eur J Vasc Endovasc Surg 2016; 51:21. [PMID: 26526108 DOI: 10.1016/j.ejvs.2015.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Y Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
| | - M Ohana
- Department of Diagnostic Radiology, University Hospital of Strasbourg, France
| | - N Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
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The Optimized Fabrication of Nanobubbles as Ultrasound Contrast Agents for Tumor Imaging. Sci Rep 2015; 5:13725. [PMID: 26333917 PMCID: PMC4558543 DOI: 10.1038/srep13725] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 07/31/2015] [Indexed: 12/23/2022] Open
Abstract
Nanobubbles, which have the potential for ultrasonic targeted imaging and treatment in tumors, have been a research focus in recent years. With the current methods, however, the prepared uniformly sized nanobubbles either undergo post-formulation manipulation, such as centrifugation, after the mixture of microbubbles and nanobubbles, or require the addition of amphiphilic surfactants. These processes influence the nanobubble stability, possibly create material waste, and complicate the preparation process. In the present work, we directly prepared uniformly sized nanobubbles by modulating the thickness of a phospholipid film without the purification processes or the addition of amphiphilic surfactants. The fabricated nanobubbles from the optimal phospholipid film thickness exhibited optimal physical characteristics, such as uniform bubble size, good stability, and low toxicity. We also evaluated the enhanced imaging ability of the nanobubbles both in vitro and in vivo. The in vivo enhancement intensity in the tumor was stronger than that of SonoVue after injection (UCA; 2 min: 162.47 ± 8.94 dB vs. 132.11 ± 5.16 dB, P < 0.01; 5 min: 128.38.47 ± 5.06 dB vs. 68.24 ± 2.07 dB, P < 0.01). Thus, the optimal phospholipid film thickness can lead to nanobubbles that are effective for tumor imaging.
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Pazinato DV, Stein BV, de Almeida WR, Werneck RDO, Mendes Júnior PR, Penatti OAB, Torres RDS, Menezes FH, Rocha A. Pixel-Level Tissue Classification for Ultrasound Images. IEEE J Biomed Health Inform 2014; 20:256-67. [PMID: 25561598 DOI: 10.1109/jbhi.2014.2386796] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pixel-level tissue classification for ultrasound images, commonly applied to carotid images, is usually based on defining thresholds for the isolated pixel values. Ranges of pixel values are defined for the classification of each tissue. The classification of pixels is then used to determine the carotid plaque composition and, consequently, to determine the risk of diseases (e.g., strokes) and whether or not a surgery is necessary. The use of threshold-based methods dates from the early 2000s but it is still widely used for virtual histology. METHODOLOGY/PRINCIPAL FINDINGS We propose the use of descriptors that take into account information about a neighborhood of a pixel when classifying it. We evaluated experimentally different descriptors (statistical moments, texture-based, gradient-based, local binary patterns, etc.) on a dataset of five types of tissues: blood, lipids, muscle, fibrous, and calcium. The pipeline of the proposed classification method is based on image normalization, multiscale feature extraction, including the proposal of a new descriptor, and machine learning classification. We have also analyzed the correlation between the proposed pixel classification method in the ultrasound images and the real histology with the aid of medical specialists. CONCLUSIONS/SIGNIFICANCE The classification accuracy obtained by the proposed method with the novel descriptor in the ultrasound tissue images (around 73%) is significantly above the accuracy of the state-of-the-art threshold-based methods (around 54%). The results are validated by statistical tests. The correlation between the virtual and real histology confirms the quality of the proposed approach showing it is a robust ally for the virtual histology in ultrasound images.
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Jager NA, Westra J, Golestani R, van Dam GM, Low PS, Tio RA, Slart RH, Boersma HH, Bijl M, Zeebregts CJ. Folate Receptor-β Imaging Using 99mTc-Folate to Explore Distribution of Polarized Macrophage Populations in Human Atherosclerotic Plaque. J Nucl Med 2014; 55:1945-51. [DOI: 10.2967/jnumed.114.143180] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Xu G, Zhu J, Liu X. Stratifying carotid diseases for endovascular treatments. INTERVENTIONAL NEUROLOGY 2014; 1:16-21. [PMID: 25187762 DOI: 10.1159/000338358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endovascular angioplasty and stenting (CAS) has evolved as an alternative for treating occlusive carotid diseases in recent years. Carotid diseases are characterized by manifold etiologies and miscellaneous clinical manifestations. Although CAS is efficacious in treating patients with occlusive carotid diseases as a whole, the long-term risk-benefit ratio may vary in individual patients. Interventional strategies, such as angioplasty and stenting, should be individualized based on the etiology and clinical profiles to maximize the benefits and minimize the hazards of treatment. Based on recent publications, this review proposes a stratified treatment strategy for occlusive carotid diseases.
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Affiliation(s)
- Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Juehua Zhu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Glaudemans AWJM, Bonanno E, Galli F, Zeebregts CJ, de Vries EFJ, Koole M, Luurtsema G, Boersma HH, Taurino M, Slart RHJA, Signore A. In vivo and in vitro evidence that ⁹⁹mTc-HYNIC-interleukin-2 is able to detect T lymphocytes in vulnerable atherosclerotic plaques of the carotid artery. Eur J Nucl Med Mol Imaging 2014; 41:1710-9. [PMID: 24737117 DOI: 10.1007/s00259-014-2764-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Recent advances in basic science have established that inflammation plays a pivotal role in the pathogenesis of atherosclerosis. Inflammatory cells are thought to be responsible for the transformation of a stable plaque into a vulnerable one. Lymphocytes constitute at least 20 % of infiltrating cells in these vulnerable plaques. Therefore, the interleukin-2 (IL-2) receptor, being overexpressed on activated T lymphocytes, may represent an attractive biomarker for plaque vulnerability. The aim of this study was to evaluate the specificity of radiolabelled IL-2 [(99m)Tc-hydrazinonicotinamide (HYNIC)-IL-2] for imaging the lymphocytic infiltration in carotid plaques in vivo by planar and single photon emission computed tomography (SPECT)/CT imaging and ex vivo by microSPECT and autoradiography. METHODS For the in vivo study, ten symptomatic patients with advanced plaques at ultrasound who were scheduled for carotid endarterectomy underwent (99m)Tc-HYNIC-IL-2 scintigraphy. The images were analysed visually on planar and SPECT images and semi-quantitatively on SPECT images by calculating target to background (T/B) ratios. After endarterectomy, immunomorphological evaluation and immunophenotyping were performed on plaque slices. For the ex vivo studies, four additional patients were included and, after in vitro incubation of removed plaques with (99m)Tc-HYNIC-IL-2, autoradiography was performed and microSPECT images were acquired. RESULTS Visual analysis defined clear (99m)Tc-HYNIC-IL-2 uptake in seven of the ten symptomatic plaques. SPECT/CT allowed visualization in eight of ten. A significant correlation was found between the number of CD25+ lymphocytes and the total number of CD25+ cells in the plaque and the T/B ratio with adjacent carotid artery as background (Pearson's r = 0.89, p = 0.003 and r = 0.87, p = 0.005, respectively). MicroSPECT imaging showed clear (99m)Tc-HYNIC-IL-2 uptake within the plaque wall and not in the lipidic core. With autoradiography, only CD3+ lymphocytes were found to be labelled. CONCLUSION These in vivo and ex vivo studies confirm the specificity of (99m)Tc-HYNIC-IL-2 for imaging activated T lymphocytes in carotid plaques. (99m)Tc-HYNIC-IL-2 is a true marker for the inflamed plaque and therefore of plaque instability.
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Affiliation(s)
- Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands,
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Kolkert JL, Meerwaldt R, Loonstra J, Schenk M, van der Palen J, van den Dungen JJ, Zeebregts CJ. Relation between B-mode Gray-scale Median and Clinical Features of Carotid Stenosis Vulnerability. Ann Vasc Surg 2014; 28:404-10. [DOI: 10.1016/j.avsg.2013.04.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/23/2013] [Accepted: 04/27/2013] [Indexed: 10/25/2022]
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Vicenzini E, Petolicchio B, Toscano M, La Cesa S, Puledda F, Lenzi GL, Di Piero V. Cardioembolic stroke: Protective effect of a severe internal carotid artery stenosis in a patient with cardiac embolism. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41 Suppl 1:22-27. [PMID: 23303714 DOI: 10.1002/jcu.22011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/15/2012] [Indexed: 06/01/2023]
Abstract
Cardioembolic stroke is generally caused by intracranial artery occlusion. Clots may be identified in the intracranial vessels by means of conventional neuroimaging in the acute phase. High-resolution ultrasonography may show some features suggestive of cardiac emboli when occluding extracranial carotid arteries. We describe a patient with cardioembolic ischemic stroke in the right hemisphere in whom a left internal carotid artery stenosis paradoxically protected the ipsilateral hemisphere from distal intracranial embolism. The patient also presented multiple acute ischemic embolic lesions in the right middle cerebral artery territory and in the right occipital lobe, which was fed by the posterior cerebral artery, anomally originating from the right carotid siphon. Interestingly, the left internal carotid artery--which showed a severe preexisting stenosis--was occluded by the cardiac clot, whereas the right internal carotid artery only presented a moderate stenosis that had probably allowed the clots to pass. Therefore, the severe left internal carotid artery stenosis may have blocked the cardiac embolus, preventing it from reaching the ipsilateral hemisphere.
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Affiliation(s)
- Edoardo Vicenzini
- Department of Neurology and Psychiatry, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy
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Walterbusch G. Zur „S3-Leitlinie Carotisstenose“. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00398-013-1007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Menezes FH, Silveira TDC, Silveira SAF, Salles-Cunha SX, Metze K, Menezes ASCD. Comparacoes preliminares entre a histologia virtual ultrassonografica in vivo e os achados histopatologicos da placa carotidea produto de endarterectomia. J Vasc Bras 2013. [DOI: 10.1590/jvb.2013.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: A doença aterosclerótica da carótida extracraniana é uma das principais causas evitáveis de acidente vascular cerebral isquêmico (AVCi), sendo este a segunda causa mais comum de morte nos países desenvolvidos. Nos grandes estudos sobre a cirurgia carotídea, a indicação estava embasada fundamentalmente no grau de estenose arterial. Analisar somente o grau de estenose, entretanto, não revela todas as características da placa, na medida em que a morfologia e a composição da placa complementam a avaliação da doença carotídea avançada e são fundamentais para a análise e o acompanhamento da maioria das placas carotídeas tratadas clinicamente. OBJETIVO: Correlacionar a caracterização dos componentes da placa de ateroma pela histologia virtual ultrassonográfica (HVUS) com a histologia. MÉTODOS: As imagens pré-operatórias obtidas por ultrassonografia transcutânea de 12 placas de ateroma de bifurcação carotídea foram submetidas a um programa de computador, o qual correlacionou os níveis de cinza com os prováveis componentes da placa da bifurcação carotídea (HVUS). Estes achados foram correlacionados com o exame anatomopatológico das placas coletadas pela cirurgia de endarterectomia. RESULTADOS: O coeficiente de correlação de Pearson para os conteúdos de lipídeos e músculo/tecido fibroso foram, respectivamente, R=0,83 para gordura e R=0,91 para músculo/tecido fibroso. Quanto ao cálcio e ao sangue, foram R=0,05 e R=0,19, respectivamente. CONCLUSÕES: O presente trabalho corrobora a literatura demonstrando que a histologia virtual computadorizada baseada em ultrassonografia transcutânea apresenta boa correlação com os achados da histologia quanto ao conteúdo da placa. Maiores estudos para a padronização da técnica e o aperfeiçoamento do programa de análise permitirão maior uso clínico deste método.
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Noh SM, Choi WJ, Kang BT, Jeong SW, Lee DK, Schellingerhout D, Yeo JS, Kim DE. Complementarity between (18)F-FDG PET/CT and Ultrasonography or Angiography in Carotid Plaque Characterization. J Clin Neurol 2013; 9:176-85. [PMID: 23894241 PMCID: PMC3722469 DOI: 10.3988/jcn.2013.9.3.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 01/15/2023] Open
Abstract
Background and Purpose To estimate clinical roles of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) versus angiography and ultrasonography in carotid plaque characterization. Methods We characterized two groups of patients with recently (<1 month) symptomatic (n=14; age=71.8±8.6 years, mean±SD) or chronic (n=13, age=68.9±9.0 years) carotid stenosis using a battery of imaging tests: diffusion magnetic resonance (MR) imaging, MR or transfemoral angiography, duplex ultrasonography (DUS), and carotid FDG-PET/computed tomography. Results The degree of angiographic stenosis was greater in patients with recently symptomatic carotid plaques (67.5±21.5%) than in patients with chronic carotid plaques (32.4±26.8%, p=0.001). Despite the significant difference in the degree of stenosis, lesional maximum standardized uptake values (maxSUVs) on the carotid FDG-PET did not differ between the recently symptomatic (1.56±0.53) and chronic (1.56±0.34, p=0.65) stenosis groups. However, lesional-to-contralesional maxSUV ratios were higher in the recently symptomatic stenosis group (113±17%) than in the chronic stenosis group (98±10%, p=0.017). The grayscale median value of the lesional DUS echodensities was lower in the recently symptomatic stenosis group (28.2±10.0, n=9) than in the chronic stenosis group (53.9±14.0, n=8; p=0.001). Overall, there were no significant correlations between angiographic stenosis, DUS echodensity, and FDG-PET maxSUV. Case/subgroup analyses suggested complementarity between imaging modalities. Conclusions There were both correspondences and discrepancies between the carotid FDG-PET images and DUS or angiography data. Further studies are required to determine whether FDG-PET could improve the clinical management of carotid stenosis.
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Affiliation(s)
- Sang-Mi Noh
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Saito H, Kuroda S, Hirata K, Magota K, Shiga T, Tamaki N, Yoshida D, Terae S, Nakayama N, Houkin K. Validity of Dual MRI and18F-FDG PET Imaging in Predicting Vulnerable and Inflamed Carotid Plaque. Cerebrovasc Dis 2013; 35:370-7. [DOI: 10.1159/000348846] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/04/2013] [Indexed: 11/19/2022] Open
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den Hartog A, Bovens S, Koning W, Hendrikse J, Luijten P, Moll F, Pasterkamp G, de Borst G. Current Status of Clinical Magnetic Resonance Imaging for Plaque Characterisation in Patients with Carotid Artery Stenosis. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2012.10.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Recurrent stroke is one of severe outcomes of transient ischemic attack (TIA) and minor ischemic stroke (MIS), which are collectively termed as nondisabling stroke. However, the association between multiple risk factors and nondisabling stroke has not been fully studied. Here, we aimed to identify predicative risk factors in TIA and MIS in order to prevent recurrent nondisabling stroke. METHODS We used logistic regression methods to analysis risk factors in 620 patients with TIA or MIS between August 2006 and january 2009 and followed up to 90 days. We selected 20 factors, including age, gender, body mass index (BMI), smoking and alcohol history, blood pressure, limb weakness, speech impairment, diabetes, ischemic brain lesions, previous history of stroke (> 24 hours), coronary atherosclerotic heart disease, cardiac function insufficiency, duration of symptoms of at least 1 hour, blood lipids, lysophosphatidic acid, C-reactive protein, atrial fibrillation, and carotid artery plaque in ultrasound examination. RESULTS We found that limb weakness, history of cerebrovascular events, and carotid artery plaque in ultrasound examination were risk factors of recurrent stroke within 14 days, whereas the factors for the recurrence within 90 days were duration of symptoms of at least 1 hour, speech impairment, limb weakness, BMI of at least 25 kg/m2, history of cerebrovascular events, and carotid artery plaque in ultrasound examination. CONCLUSION Six risk factors are associated with recurrent nondisabling stroke, including symptom duration of at least 1 hour, speech impairment, limb weakness, BMI of at least 25 kg/m2, history of cerebrovascular events, and carotid artery plaque in ultrasound examination. Thus, identification and prevention of these risk factors may reduce recurrent stroke.
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W van Lammeren G, L Moll F, Borst GJD, de Kleijn DPV, P M de Vries JP, Pasterkamp G. Atherosclerotic plaque biomarkers: beyond the horizon of the vulnerable plaque. Curr Cardiol Rev 2012; 7:22-7. [PMID: 22294971 PMCID: PMC3131712 DOI: 10.2174/157340311795677680] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 10/16/2010] [Accepted: 01/07/2011] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local plaque vulnerability, leading to thrombus formation and cardiovascular events. Due to the burden of cardiovascular disease, identification of patients at risk for cardiovascular events and treatment stratification is needed. The predictive power of classical risk factors is limited, especially in patients with manifest atherosclerosis. Imaging modalities have focused on the characteristics of the vulnerable plaque. However, it has become evident that not all so-called vulnerable plaques lead to rupture and subsequent thrombosis. The latter obviously limits the positive predictive value for imaging assessment of plaques and patients at risk. Serum biomarkers have also been studied extensively, but have very limited application in a clinical setting for risk stratification. In line with the important relation between vulnerable plaques and cardiovascular events, plaque biomarker studies have been initiated. These longitudinal studies are based on the concept, that a vulnerable plaque contains predictive information for future cardiovascular events, also in other territories of the vascular tree. Results look promising and plaque markers can be used to develop imaging modalities to identify patients at risk, or to monitor treatment effect. Plaque biomarker studies do not challenge the definition of the vulnerable plaque, but use its concept in favor of prediction improvement for vascular patients.
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Affiliation(s)
- Guus W van Lammeren
- Experimental Cardiology Laboratory, University Medical Center Utrecht, The Netherlands
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Single-Chain VEGF/Cy5.5 Targeting VEGF Receptors to Indicate Atherosclerotic Plaque Instability. Mol Imaging Biol 2012; 15:250-61. [DOI: 10.1007/s11307-012-0594-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Aldemir E, Apaydin M, Varer M, Uluc E. Echolucency of carotid plaques and cerebrovascular events. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:399-404. [PMID: 22678951 DOI: 10.1002/jcu.21951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/23/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To assess the relationship between carotid plaque echogenicity and degree of stenosis with acute and chronic stroke. METHODS A retrospective study of cerebral MRI and carotid B-mode and Doppler ultrasonography in 60 patients with stroke. Plaque echogenicity was graded as echolucent (1), predominantly echolucent (2), predominantly echogenic (3), or echogenic (4). Sonographic findings were compared between patients with acute (group 1) and chronic (group 2) stroke. RESULTS In group 1 (n = 39 patients), the carotid plaques were grade 1 in 21, grade 2 in 22, grade 3 in 9, and grade 4 in 4 carotid arteries. In group 2 (n = 21), the carotid plaques were grade 1 in 2, grade 2 in 8, grade 3 in 4, and grade 4 in 11 carotid arteries. Plaque echogenicity was lower in group 1 than in group 2 (p < 0.05). Plaque echolucency was associated independently with acute stroke from the degree of stenosis. CONCLUSIONS Patients with acute infarcts have predominantly echolucent plaques, regardless of the degree of stenosis.
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Affiliation(s)
- Evren Aldemir
- Radiology Clinic, Trabzon Vakfıkebir Health Ministry Hospital, Trabzon, Turkey
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Bunschoten A, Buckle T, Visser NL, Kuil J, Yuan H, Josephson L, Vahrmeijer AL, van Leeuwen FWB. Multimodal interventional molecular imaging of tumor margins and distant metastases by targeting αvβ3 integrin. Chembiochem 2012; 13:1039-45. [PMID: 22505018 DOI: 10.1002/cbic.201200034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Indexed: 12/20/2022]
Abstract
α(v)β(3) integrin is involved in (tumor-induced) angiogenesis and is a promising candidate for the specific visualization of both primary tumors and of their distant metastases. Combination of radioactive and fluorescent imaging labels in a single multimodal, or rather hybrid, RGD-based imaging agent enables integration of pre-, intra-, and postoperative angiogenesis imaging. A hybrid imaging agent targeting the α(v)β(3) integrin--(111)In-MSAP-RGD (MSAP = multifunctional single-attachment-point reagent), which contains a targeting moiety, a pentetic acid (DTPA) chelate, and a cyanine dye--was evaluated for its potential value in combined lesion detection and interventional molecular imaging in a 4T1 mouse breast cancer model. SPECT/CT and fluorescence imaging were used to visualize the tumor in vivo. Tracer distribution was evaluated ex vivo down to the microscopic level. The properties of (111)In-MSAP-RGD were compared with those of (111)In-DTPA-RGD. Biodistribution studies revealed a prolonged retention and increased tumor accumulation of (111)In-MSAP-RGD relative to (111)In-DTPA-RGD. With (111)In-MSAP-RGD, identical features could be visualized preoperatively (SPECT/CT) and intraoperatively (fluorescence imaging). As well as the primary tumor, (111)In-MSAP-RGD also enabled detection and accurate excision of distant metastases in the head and neck region of the mice. Therefore, the hybrid RGD derivative (111)In-MSAP-RGD shows potential in preoperative planning and fluorescence-based surgical intervention.
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Affiliation(s)
- Anton Bunschoten
- Interventional Molecular Imaging, Department of Radiology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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Kingstone LL, Currie GM, Torres C. The Pathogenesis, Analysis, and Imaging Methods of Atherosclerotic Disease of the Carotid Artery: Review of the Literature. J Med Imaging Radiat Sci 2011; 43:84-94. [PMID: 31052031 DOI: 10.1016/j.jmir.2011.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/11/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
Cerebrovascular (CVA) accidents are the second leading cause of death worldwide and their numbers are increasing. Strokes can arise from several causes, with extracranial carotid artery atherosclerosis (CAS) being one of the leading causes. CAS causes these strokes either by diminishing blood flow distal to the diseased stenotic segment of the artery or, as more recently discovered, by a thromboembolic event of material from the plaque site itself. The specific etiology of CAS is unknown, but causative factors in the formation of atherosclerotic plaque of the carotid arteries have been linked to specific morphological areas within the plaque that may be vulnerable to rupture, leading to thromboemboli into the cerebrovascular circulation. The current means for imaging and reporting CAS is through the measurement of the severity of luminal diameter stenosis caused by atherosclerotic disease. Recent developments in medical imaging techniques have expanded the role of early imaging and detection of CAS. Although current practice uses luminal narrowing as the surrogate marker to assess CAS, it has been recently discovered that plaque morphology and composition may help predict the clinical behavior of CAS and better determine the necessary medical intervention or risk of stroke. Although a single optimized imaging modality for standard CAS imaging has not been established or agreed on, various modalities can provide key elements to a successful exam. This review article will evaluate the most commonly used methods for CAS imaging along with the new and upcoming uses, advantages, and limitations for advanced CAS imaging.
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Affiliation(s)
- Lysa Legault Kingstone
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - Geoffrey M Currie
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Carlos Torres
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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Bruggink JL, Slart RH, Pol JA, Reijnen MM, Zeebregts CJ. Current Role of Imaging in Diagnosing Aortic Graft Infections. Semin Vasc Surg 2011; 24:182-90. [DOI: 10.1053/j.semvascsurg.2011.10.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Yun WS, Kwun WH, Suh BY. The early and mid-term results of carotid artery stenting in high-risk patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80:283-8. [PMID: 22066049 PMCID: PMC3204673 DOI: 10.4174/jkss.2011.80.4.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 08/12/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate early and mid-term outcomes of carotid artery stenting (CAS). METHODS We retrospectively reviewed 111 patients who were treated for carotid stenosis between October 2004 and December 2009 (42 CASs and 69 carotid endarterectomies [CEAs]). RESULTS CAS group was older than CEA group (70 years vs. 67 years, P = 0.001). Coronary artery disease and high lesion above the 2nd cervical vertebral body were more common in CAS group (29% vs. 13%, P = 0.002; 4% vs. 24%, P = 0.004). The 30-days stroke rate was higher in CAS group (10% vs. 1% in CEA group, P = 0.067, Fisher's exact test). New brain lesions on diffusion-weighted magnetic resonance imaging were more common in CAS group (48% vs. 20% in CEA group, P = 0.002, chi-square test). The 1-, 3-year freedom from stroke were 91%, 84% in CAS group and 99%, 99% in CEA group (P = 0.007, log-rank test). Univariate analysis showed that female gender and age > 70 years were related with postprocedural neurological complications (P = 0.046 and P = 0.007, log-rank test). However, none were independent risk factors on multivariate analysis. CONCLUSION In our series, the rates of peri-procedural neurological complications in CAS group were significantly high. These results suggest that more experience and restricted patient selection will be needed for CAS.
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Affiliation(s)
- Woo-Sung Yun
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Avgerinos ED, Kadoglou NPE, Moulakakis KG, Giannakopoulos TG, Liapis CD. Current role of biomarkers in carotid disease: a systematic review. Int J Stroke 2011; 6:337-45. [PMID: 21745345 DOI: 10.1111/j.1747-4949.2011.00623.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Accumulating evidence suggests that carotid plaque vulnerability can be used as a determinant of ischemic stroke risk stratification and carotid intervention. Novel markers of high-risk carotid plaque in patients are needed. SUMMARY OF REVIEW Advances in cellular and molecular pathophysiology, the demand for accurately predicting carotid risk, and choosing the optimal prevention strategy are stimulating great interest in the development of novel surrogate markers. Biomarkers in cardiovascular disease are expected to predict the natural history, clinical outcomes, and the efficacy of disease-modifying interventions. We aimed to review the literature regarding clinical data on novel serum biomarkers related to ischemic cerebrovascular events associated with carotid artery disease. We provide background information on the biomarkers related to all aspects of carotid disease: natural history, carotid intervention strategies for symptomatic and asymptomatic patients, perioperative risk prediction, and their therapeutic implications. CONCLUSION At present, heterogeneous data support evidence that biological markers can help existing practices to more accurately assess patients at risk for stroke. Randomized-controlled trials for carotid artery disease and carotid intervention, incorporating biomarkers, are needed.
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Affiliation(s)
- Efthimios D Avgerinos
- Department of Vascular Surgery, Attikon University Hospital, Medical School, Athens, Greece
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Hermus L, Schuitemaker JHN, Tio RA, Breek JC, Slart RHJA, de Boef E, Zeebregts CJ. Novel serum biomarkers in carotid artery stenosis: useful to identify the vulnerable plaque? Clin Biochem 2011; 44:1292-8. [PMID: 21939648 DOI: 10.1016/j.clinbiochem.2011.08.1141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Serum biomarkers representing inflammatory activity in vulnerable carotid plaques may be used to identify high-risk patients for cerebral ischemic events. We aimed to analyze the relationship between concentrations of four novel biomarkers and neurological symptoms: Neopterin, PTX3, sCD163, and sTREM-1. In addition, we analyzed the relationship between these markers and the presence of coronary (CAD) and peripheral (PAD) artery disease. DESIGN AND METHODS Serum biomarker levels were determined in 100 patients undergoing carotid endarterectomy; 33 for stroke, 32 for transient ischemic attack, and 23 for amaurosis fugax. 12 Patients were asymptomatic. Risk factors for atherosclerotic disease and history of CAD and PAD were also assessed. RESULTS Symptomatic patients did not show significantly elevated biomarker levels compared to asymptomatic patients and levels did not differ among symptomatic subgroups. Neopterin levels were elevated in patients with concomitant coronary and peripheral artery disease (CAD (32%) 10.2 ± 6.6 vs no CAD (68%) 7.6 ± 2.9 nmol/L, PAD (20%) 12.3 ± 7.4 vs no PAD (80%) 7.5 ± 3.0 nmol/L, p<0.05). sTREM-1 was elevated in patients with CAD (50.8 ± 53.2 vs 28.0 ± 31.6 ng/L, p<0.05). PTX3 and sCD163 were not significantly elevated in CAD nor PAD. CONCLUSION Our findings suggest that serum neopterin and sTREM-1 levels may be related to the presence of atherosclerotic disease, but not to carotid plaque vulnerability.
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Affiliation(s)
- Linda Hermus
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, The Netherlands
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Zhao R, Hollis CP, Zhang H, Sun L, Gemeinhart RA, Li T. Hybrid Nanocrystals: Achieving Concurrent Therapeutic and Bioimaging Functionalities toward Solid Tumors. Mol Pharm 2011; 8:1985-91. [DOI: 10.1021/mp200154k] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rongsheng Zhao
- Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky 40536, United States
| | - Christin P. Hollis
- Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky 40536, United States
| | - Hua Zhang
- Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky 40536, United States
| | - Lili Sun
- Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky 40536, United States
| | - Richard A. Gemeinhart
- Biopharmaceutical Sciences, Bioengineering, and Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois 60612, United States
| | - Tonglei Li
- Pharmaceutical Sciences, University of Kentucky, Lexington, Kentucky 40536, United States
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Boersma HH, de Haas HJ, Reutelingsperger CPM, Slart RHJA. P-selectin imaging in cardiovascular disease: what you see is what you get? J Nucl Med 2011; 52:1337-8. [PMID: 21816970 DOI: 10.2967/jnumed.111.090506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Franquet A, Avril S, Le Riche R, Badel P. Identification of heterogeneous elastic properties in stenosed arteries: a numerical plane strain study. Comput Methods Biomech Biomed Engin 2011; 15:49-58. [PMID: 21607891 DOI: 10.1080/10255842.2010.547192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Assessing the vulnerability of atherosclerotic plaques requires an accurate knowledge of the mechanical properties of the plaque constituents. It is possible to measure displacements in vivo inside a plaque using magnetic resonance imaging. An important issue is to solve the inverse problem that consists in estimating the elastic properties inside the plaque from measured displacements. This study focuses on the identifiability of elastic parameters, e.g. on the compromise between identification time and identification accuracy. An idealised plane strain finite element (FE) model is used. The effects of the FE mesh of the a priori assumptions about the constituents, of the measurement resolution and of the data noise are numerically investigated.
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Affiliation(s)
- Alexandre Franquet
- Center for Health and Engineering PECM CNRS UMR 5146 and IFRESIS INSERM IFR 143, Ecole Nationale Supérieure des Mines, Saint-Etienne, France.
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Bigalke B, Lindemann S, Schönberger T, Pohlmeyer I, Chiribiri A, Schuster A, Botnar RM, Griessinger CM, Pichler BJ, Gawaz M. Ex vivoimaging of injured arteries in rabbits using fluorescence-labelled glycoprotein VI-Fc. Platelets 2011; 23:1-6. [DOI: 10.3109/09537104.2011.585258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gupta AS. Nanomedicine approaches in vascular disease: a review. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2011; 7:763-79. [PMID: 21601009 DOI: 10.1016/j.nano.2011.04.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/11/2011] [Accepted: 04/05/2011] [Indexed: 01/26/2023]
Abstract
UNLABELLED Nanomedicine approaches have revolutionized the treatment of cancer and vascular diseases, where the limitations of rapid nonspecific clearance, poor biodistribution and harmful side effects associated with direct systemic drug administration can be overcome by packaging the agents within sterically stabilized, long-circulating nanovehicles that can be further surface-modified with ligands to actively target cellular/molecular components of the disease. With significant advancements in genetics, proteomics, cellular and molecular biology and biomaterials engineering, the nanomedicine strategies have become progressively refined regarding the modulation of surface and bulk chemistry of the nanovehicles, control of drug release kinetics, manipulation of nanoconstruct geometry and integration of multiple functionalities on single nanoplatforms. The current review aims to capture the various nanomedicine approaches directed specifically toward vascular diseases during the past two decades. Analysis of the promises and limitations of these approaches will help identify and optimize vascular nanomedicine systems to enhance their efficacy and clinical translation in the future. FROM THE CLINICAL EDITOR Nanomedicine-based approaches have had a major impact on the treatment and diagnosis of malignancies and vascular diseases. This review discusses various nanomedicine approaches directed specifically toward vascular diseases during the past two decades, highlighting their advantages, limitations and offering new perspectives on future applications.
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Affiliation(s)
- Anirban Sen Gupta
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Abstract
OBJECTIVE Quantification of 18-fluorodeoxyglucose (FDG) uptake in inflamed high-risk carotid atherosclerotic plaques is challenged by the spatial resolution of positron emission tomography (PET) and luminal blood activity. Late acquisition protocols have been used to overcome these challenges to enhance the contrast between the plaque and blood-pool FDG activity. However, for prospective studies the late acquisition is inconvenient for the patient and staff, and most retrospective studies of plaque uptake use data from early acquisition protocols. The objective was to evaluate changes in the quantification methods of FDG uptake in carotid artery plaques between early and late PET scans. METHODS FDG uptake 1 and 3 h after tracer injection was compared in 19 carotid artery plaques. The average plaque maximum standardized uptake value (SUVmax) and a target to background ratio (TBR), using venous blood-pool activity as background, were evaluated at the two time points. These methods have been shown earlier to quantitate the degree of inflammation in late hour scans. RESULTS A good individual plaque FDG uptake consistency was found between the two time points for SUVmax, r²=0.86. In contrast, the ratio method did not conserve the results between the two time points: TBR r²=0.34. For both methods, absolute values changed over time. TBR values generally increased as blood pool activity decreased, whereas the individual plaque SUVmax values showed both increases and decreases over time. CONCLUSION Identification of carotid plaque inflammation with PET can be performed 1 h after FDG injection using SUVmax for plaque FDG uptake quantification.
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Mahmoudi M, Hosseinkhani H, Hosseinkhani M, Boutry S, Simchi A, Journeay WS, Subramani K, Laurent S. Magnetic resonance imaging tracking of stem cells in vivo using iron oxide nanoparticles as a tool for the advancement of clinical regenerative medicine. Chem Rev 2010; 111:253-80. [PMID: 21077606 DOI: 10.1021/cr1001832] [Citation(s) in RCA: 271] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Winter PM, Caruthers SD, Lanza GM, Wickline SA. Quantitative cardiovascular magnetic resonance for molecular imaging. J Cardiovasc Magn Reson 2010; 12:62. [PMID: 21047411 PMCID: PMC2987770 DOI: 10.1186/1532-429x-12-62] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 11/03/2010] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) molecular imaging aims to identify and map the expression of important biomarkers on a cellular scale utilizing contrast agents that are specifically targeted to the biochemical signatures of disease and are capable of generating sufficient image contrast. In some cases, the contrast agents may be designed to carry a drug payload or to be sensitive to important physiological factors, such as pH, temperature or oxygenation. In this review, examples will be presented that utilize a number of different molecular imaging quantification techniques, including measuring signal changes, calculating the area of contrast enhancement, mapping relaxation time changes or direct detection of contrast agents through multi-nuclear imaging or spectroscopy. The clinical application of CMR molecular imaging could offer far reaching benefits to patient populations, including early detection of therapeutic response, localizing ruptured atherosclerotic plaques, stratifying patients based on biochemical disease markers, tissue-specific drug delivery, confirmation and quantification of end-organ drug uptake, and noninvasive monitoring of disease recurrence. Eventually, such agents may play a leading role in reducing the human burden of cardiovascular disease, by providing early diagnosis, noninvasive monitoring and effective therapy with reduced side effects.
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Affiliation(s)
- Patrick M Winter
- Cincinnati Children's Hospital, Department of Radiology, 3333 Burnet Ave., ML 5033, Cincinnati, OH, 45229, USA
| | - Shelton D Caruthers
- Washington University, C-TRAIN Labs, 660 S. Euclid Ave., Campus Box 8215, St. Louis, MO, 63110, USA
| | - Gregory M Lanza
- Washington University, C-TRAIN Labs, 660 S. Euclid Ave., Campus Box 8215, St. Louis, MO, 63110, USA
| | - Samuel A Wickline
- Washington University, C-TRAIN Labs, 660 S. Euclid Ave., Campus Box 8215, St. Louis, MO, 63110, USA
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Vicenzini E, Giannoni MF, Ricciardi MC, Toscano M, Sirimarco G, Di Piero V, Lenzi GL. Noninvasive imaging of carotid arteries in stroke: emerging value of real-time high-resolution sonography in carotid occlusion due to cardiac embolism. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:1635-1641. [PMID: 20966475 DOI: 10.7863/jum.2010.29.11.1635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Comprehension of the pathophysiologic characteristics of atherosclerosis has focused its attention on the study of dynamic and metabolic processes involving the vessel wall as possible causes of stroke. When compared with conventional radiologic techniques, sonography has the main advantage of being a real-time imaging modality. We report 2 acute stroke cases in which carotid sonography showed some dynamic features that could not be identified with computed tomography (CT) and magnetic resonance angiography (MRA). METHODS Carotid sonography with high-resolution probes (9-14 MHz) was compared with CT and MRA findings showing carotid axis occlusion in 2 patients with acute stroke. RESULTS In case 1, the internal carotid artery occlusion observed on CT and MRA was interpreted as a dissection on a clinical basis, but sonography showed a mobile embolus originating from the heart in the internal carotid artery. In case 2, the occlusion of the whole carotid axis observed on CT and MRA was instead related to a heart-originating embolus floating in the common carotid artery. CONCLUSIONS The evaluation of dynamic aspects of atherosclerosis is fundamental to understanding the pathophysiologic characteristics of stroke. Sonography is fundamental in carotid artery imaging for its possibility of showing dynamic processes that could be misdiagnosed with "static" imaging. The correct identification of the pathophysiologic characteristics of stroke in these cases could have led to different diagnostic and therapeutic algorithms.
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Affiliation(s)
- Edoardo Vicenzini
- Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università 30, Rome, Italy.
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Carotid Endarterectomy for Symptomatic, but “Haemodynamically Insignificant” Carotid Stenosis. Eur J Vasc Endovasc Surg 2010; 40:475-82. [DOI: 10.1016/j.ejvs.2010.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 07/12/2010] [Indexed: 12/14/2022]
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Lucignani G, Schäfers M. PET, CT and MRI characterisation of the atherosclerotic plaque. Eur J Nucl Med Mol Imaging 2010; 37:2398-402. [DOI: 10.1007/s00259-010-1634-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Yazdani SK, Vorpahl M, Ladich E, Virmani R. Pathology and Vulnerability of Atherosclerotic Plaque: Identification, Treatment Options, and Individual Patient Differences for Prevention of Stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 12:297-314. [DOI: 10.1007/s11936-010-0074-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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